Texas 2023 - 88th Regular

Texas House Bill HB5233 Compare Versions

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1	1	88R8764 CJD-F
2	2	By: Bucy H.B. No. 5233
3	3
4	4
5	5	A BILL TO BE ENTITLED
6	6	AN ACT
7	7	relating to expedited credentialing for licensed behavior analysts
8	8	providing services under a managed care plan.
9	9	BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
10	10	SECTION 1. Chapter 1452, Insurance Code, is amended by
11	11	adding Subchapter F to read as follows:
12	12	SUBCHAPTER F. EXPEDITED CREDENTIALING PROCESS FOR CERTAIN BEHAVIOR
13	13	ANALYSTS
14	14	Sec. 1452.251. DEFINITIONS. In this subchapter:
15	15	(1) "Applicant" means a behavior analyst applying for
16	16	expedited credentialing under this subchapter.
17	17	(2) "Enrollee" means an individual who is eligible to
18	18	receive health care services under a managed care plan.
19	19	(3) "Health care provider" means an individual who is
20	20	licensed, certified, or otherwise authorized to provide health care
21	21	services in this state.
22	22	(4) "Managed care plan" means a health benefit plan
23	23	under which health care services are provided to enrollees through
24	24	contracts with health care providers and that requires enrollees to
25	25	use participating providers or that provides a different level of
26	26	coverage for enrollees who use participating providers. The term
27	27	includes a health benefit plan issued by:
28	28	(A) a health maintenance organization;
29	29	(B) a preferred provider benefit plan issuer; or
30	30	(C) any other entity that issues a health benefit
31	31	plan, including an insurance company.
32	32	(5) "Participating provider" means a health care
33	33	provider who has contracted with a health benefit plan issuer to
34	34	provide services to enrollees.
35	35	(6) "Professional practice" means a business entity
36	36	that is owned by one or more behavior analysts.
37	37	Sec. 1452.252. APPLICABILITY. This subchapter applies only
38	38	to a behavior analyst who joins an established professional
39	39	practice that has a contract with a managed care plan.
40	40	Sec. 1452.253. ELIGIBILITY REQUIREMENTS. To qualify for
41	41	expedited credentialing under this subchapter and payment under
42	42	Section 1452.254, a behavior analyst must:
43	43	(1) be licensed in this state by, and in good standing
44	44	with, the Texas Department of Licensing and Regulation;
45	45	(2) submit all documentation and other information
46	46	required by the managed care plan issuer to begin the credentialing
47	47	process required for the issuer to include the behavior analyst in
48	48	the plan's network; and
49	49	(3) agree to comply with the terms of the managed care
50	50	plan's participating provider contract with the behavior analyst's
51	51	established professional practice.
52	52	Sec. 1452.254. PAYMENT OF BEHAVIOR ANALYST DURING
53	53	CREDENTIALING PROCESS. After an applicant has submitted the
54	54	information required by the managed care plan issuer under Section
55	55	1452.253, the issuer shall, for payment purposes only, treat the
56	56	applicant as if the applicant is a participating provider in the
57	57	plan's network when the applicant provides services to the plan's
58	58	enrollees, including:
59	59	(1) authorizing the applicant to collect copayments
60	60	from the enrollees; and
61	61	(2) making payments to the applicant.
62	62	Sec. 1452.255. DIRECTORY ENTRIES. Pending the approval of
63	63	an application submitted under Section 1452.253, the managed care
64	64	plan issuer may exclude the applicant from the plan's directory,
65	65	Internet website listing, or other listing of participating
66	66	providers.
67	67	Sec. 1452.256. EFFECT OF FAILURE TO MEET CREDENTIALING
68	68	REQUIREMENTS. If, on completion of the credentialing process, the
69	69	managed care plan issuer determines that the applicant does not
70	70	meet the issuer's credentialing requirements:
71	71	(1) the issuer may recover from the applicant or the
72	72	applicant's professional practice an amount equal to the difference
73	73	between payments for in-network benefits and out-of-network
74	74	benefits; and
75	75	(2) the applicant or the applicant's professional
76	76	practice may retain any copayments collected or in the process of
77	77	being collected as of the date of the issuer's determination.
78	78	Sec. 1452.257. ENROLLEE HELD HARMLESS. An enrollee is not
79	79	responsible and shall be held harmless for the difference between
80	80	in-network copayments paid by the enrollee to a behavior analyst
81	81	who is determined to be ineligible under Section 1452.256 and the
82	82	enrollee's managed care plan's charges for out-of-network services.
83	83	The behavior analyst and the behavior analyst's professional
84	84	practice may not charge the enrollee for any portion of the behavior
85	85	analyst's fee that is not paid or reimbursed by the plan.
86	86	Sec. 1452.258. LIMITATION ON MANAGED CARE ISSUER LIABILITY.
87	87	A managed care plan issuer that complies with this subchapter is not
88	88	subject to liability for damages arising out of or in connection
89	89	with, directly or indirectly, the payment by the issuer of a
90	90	behavior analyst treated as if the behavior analyst is a
91	91	participating provider in the plan's network.
92	92	SECTION 2. This Act takes effect immediately if it receives
93	93	a vote of two-thirds of all the members elected to each house, as
94	94	provided by Section 39, Article III, Texas Constitution. If this
95	95	Act does not receive the vote necessary for immediate effect, this
96	96	Act takes effect September 1, 2023.